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Driving a motor vehicle is a common rehabilitation goal following acquired brain injury (ABI). There is increasing interest in the use of driving simulators for driver rehabilitation post-ABI; however, there is still limited research demonstrating efficacy and acceptability. This study sought to examine the user experience of a driving simulator intervention for ABI survivors. Semi-structured interviews were conducted with 14 individuals, including 12 ABI survivors (42% male; Mean age = 53.92 years, SD age = 17.63) who completed the intervention, and 2 occupational therapist driver assessors who facilitated the intervention. Thematic analysis was adopted to analyse interview data. Findings suggest that individual differences (e.g., anxiety, previous experience) influenced participant response to training. The intervention allowed participants to practise various driving skills, re-familiarize themselves with the task of driving, and prepare for return to on-road driving within a safe environment. The intervention was perceived to be useful for enhancing driver self-awareness, autonomy, confidence and patience. Fidelity and simulator sickness were considered limitations of the simulator technology. Subjective accounts of the appropriateness of intervention components are also documented. Overall, the simulator intervention was reported to be a positive experience for participants. Themes emerging from this study can inform future driving simulator interventions for ABI survivors.

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers’ self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

Objective: The objective of this study was to address the uptake of safer vehicles and in-vehicle technologies among older adults through a better understanding of extent and use of safer vehicles ...

This paper describes changes in driving patterns over a five-year period of drivers aged 75 years and older (Year 1: Male = 68.9%; Age = M = 79.5 years, SD = 3.4 years, Range: 75.0–88.0 years) in the Candrive/Ozcandrive cohort study. Participants completed various functional and health assessments and self-reported driving questionnaires. In-vehicle data-loggers, installed in participants’ own vehicles, also monitored spatio-temporal characteristics of participants’ everyday driving trips. Data for a subset of one hundred and ninety-one Ozcandrive participants from Melbourne, Australia were analysed. Reductions in driving trip distance and frequency were observed over the five years. On average, in Year 1, participants drove 1223 (SD = 502) trips, totalling 8993 (SD = 5169) kilometers annually, decreasing significantly to 1028 trips (SD = 559) trips and 6787 (SD = 4624) kilometers in Year 5. On average, in Year 1, participants’ driving trips were around 7.5 km (SD = 3.2), decreasing in distance significantly to 6.9 km (SD 3.9) in Year 5. Log-normal General Estimating Equation (GEE) modelling was conducted for selected driving exposure measures (annual distance driven, annual trip frequency, trip distance, etc.). Reductions in overall annual distance driven were significantly associated with being female, increasing age, withdrawal from the study for health reasons and lower night-time driving comfort scores (marginally significant). Reductions in annual trip frequency were associated with increasing age and withdrawal from the study for health reasons. Results suggest drivers practiced self-regulation, which may reflect adaption to deterioration in health and functional status.

BackgroundIncorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored.MethodsWe used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial.ResultsThere was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, pConclusionsConsumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.

This study used data from the Australian Naturalistic Driving Study to study driver engagement in secondary tasks during every day driving and examine the role that various driver characteristics and driving context variables play in influencing the initiation of secondary tasks. Video from 186 randomly selected trips were viewed to identify a range of secondary tasks and to classify contextual variables at the point of task initiation (e.g. vehicle motion, weather, and light conditions). Results revealed that secondary task engagement when driving is highly prevalent, with drivers spending ∼45% of their driving time engaging in potentially distracting tasks. The results also showed that drivers make a number of strategic decisions regarding when to engage, such as waiting until the vehicle is stationary; however, they do not appear to consider some contextual factors that may impact risks, such as weather and light conditions. The findings will be useful in targeting distraction countermeasures and policies and determining the effectiveness of these in reducing driver distraction.

Using data from the Australian Naturalistic Driving Study (ANDS), this study examined patterns of secondary task engagement (e.g., mobile phone use, manipulating centre stack controls) during everyday driving trips to determine the type and duration of secondary task engaged in. Safety-related incidents associated with secondary task engagement were also examined. Results revealed that driver engagement in secondary tasks was frequent, with drivers engaging in one or more secondary tasks every 96 seconds, on average. However, drivers were more likely to initiate engagement in secondary tasks when the vehicle was stationary, suggesting that drivers do self-regulate the timing of task engagement to a certain degree. There was also evidence that drivers modified their engagement in a way suggestive of limiting their exposure to risk by engaging in some secondary tasks for shorter periods when the vehicle was moving compared to when it was stationary. Despite this, almost six percent of secondary tasks events were associated with a safety-related incident. The findings will be useful in targeting distraction countermeasures and policies and determining the effectiveness of these in managing driver distraction.

The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine whether older drivers’ DBQ scores changed across time. Five hundred and sixty Canadian older drivers (males = 61.3%) from the Candrive/Ozcandrive longitudinal study completed the DBQ yearly for four years across five time-points that were approximately 12 months apart. In Year 1, the average age of the older drivers was 76.0 years (SD = 4.5 years; Range = 70–92 years). Findings from the study support the 21-item, three-factor DBQ structure suggested by Koppel and colleagues for an Australian sample of older drivers as being acceptable in an independent sample of Canadian older drivers. In addition, Canadian older drivers’ responses to this version of the DBQ were stable across the five time-points. More specifically, there was very little change in older drivers’ self-reported violations, and no significant change for self-reported errors or lapses. The findings from the current study add further support for this version of the DBQ as being a suitable tool for examining self-reported aberrant driving behaviours in older drivers. Future research should investigate the relationship between older drivers’ self-reported aberrant driving behaviours and their performance on functional measures, their responses to other driving-related abilities and practice scales and/or questionnaires, as well their usual (or naturalistic) driving practices and/or performance on on-road driving tasks.

Vision is important for safe driving, but there is limited understanding regarding the impact of vision disorders on driving ability and safety. This systematic review evaluated and summarized evidence on the impact of vision disorders and impairment on motor vehicle crash (MVC) risk and on-road driving performance across seven databases, was prospectively registered with PROSPERO (CRD42020180135), and study quality rated using a standard tool. Forty-eight studies met the inclusion criteria for MVC risk (N = 36), on-road performance (N = 9), and both MVC risk and on-road performance (N = 3). Of these studies, less than half were rated as 'good' quality. Due to the small number of studies and often conflicting findings, it was not possible to draw firm conclusions for most vision disorders. However, evidence from several 'good' and 'fair' quality studies suggested increased MVC risk with binocular visual field impairment. There was mixed evidence regarding the impact of cataract, glaucoma, age-related macular degeneration and homonymous field loss on MVC risk and no evidence of increased MVC risk with mild VA impairment. This review highlights the need for well-designed future studies to further explore the impact of vision disorders and impairment on driving outcomes to inform evidence-based policy and fitness to drive guidelines.

Objective: To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury. Design: Pilot randomised controlled trial. Setting: Occupational therapy driver assessment and rehabilitation service. Subjects: Individuals post-acquired brain injury aiming to return to driving. Intervention: Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only. Main measures: Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale – Daytime, assessed at baseline and five weeks post-randomisation. Results: Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group ( n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group ( P = 0.373). On average, the Simulator group reported a positive change in confidence ratings ( M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change ( M = −6.97, SD = 8.47), P = 0.034. The Simulator group ( M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group ( M = −0.83, SD = 1.83, P = 0.325). Conclusions: With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.

Objective To synthesize knowledge of the risk of motor vehicle collision (MVC) following a traumatic brain injury (TBI) and the associated risk of driving impairment, as measured by on-road tests, computerized simulators, and self-reported or state-recorded driving records. Methods Our international team searched 7 databases for studies published between 1990 and 2015 of people with TBI, controls, and data concerning either MVC or driving impairment. The included articles examined the risk of MVC among people with TBI; we excluded studies that examined the risk of having a TBI associated with being involved in an MVC. Results From 13 578 search results, we included 8 studies involving 1663 participants with TBI and 4796 controls. We found no significant difference in the risk of MVC (odds ratio = 1.24, 95% confidence interval = 0.80-1.91, P = .34). When we restricted the analysis to self-report, the risk of MVC was higher for those without a TBI (odds ratio = 1.63, 95% confidence interval = 1.21-2.22, P = .002). In contrast, participants with TBI consistently performed worse during on-road assessments and had more problems with vehicular control. Conclusion Limitations of reviewed studies included small sample sizes, failure to specify TBI severity or time postinjury, and absence of objective measures of risk. Findings concerning the relationship between TBIs from non-MVC causes and crash risk are, therefore, inconclusive and do not provide evidence for major changes to existing clinical guidelines for driving with TBI.

The aim of the current study was to examine how self-reported aberrant driving behaviours change across a three time-points in a group of older drivers. Two hundred and twenty-seven older drivers (males = 69.6%) from the Candrive/Ozcandrive longitudinal study completed the Driving Behaviour Questionnaire (DBQ) each yearacross three time-points (i.e., Year 1, Year 2, Year 3). At the third time-point, older drivers ranged in age from 77 to 96 years (M = 81.74 years; SD = 3.44 years). A longitudinal confirmatory factor analysis showed that a modified 21-item, 3-factor (errors, lapses and violations) DBQ was invariant across the time period, suggesting that the structure of the questionnaire was stable across each time-point. Further, multiple domain latent growth analysis on the resultant factors for errors, lapses and violations showed that the frequency of errors remained similar across the three-year period, while violations and lapses showed very marginal decreases in frequency. These changes were independent of the absolute number of these behaviours; Drivers with higher violations or lapses in Year one, showed similar decreases in frequency as those who self-reported lower frequencies of the behaviours. These results suggest that the DBQ is a reliable tool to measure older drivers’ self-reported aberrant driving behaviours, and that these behaviours do not show much change across time. Future research should validate the self-reported responses from the DBQ with more objective measures such as those collected through naturalistic driving study (NDS) methodology or on-road driving tasks.

Objective: The aim of this study was to evaluate the consequences of frontal and oblique crashes when positioning a Hybrid III (HIII) 6-year-old child anthropometric test device (ATD) using observed child passenger postures from a naturalistic driving study (NDS). Methods: Five positions for booster-seated children aged 4–7 years were selected, including one reference position according to the FMVSS 213 ATD seating protocol and 4 based on real-world observed child passenger postures from an NDS including 2 user positions with forward tilting torso and 2 that combined both forward and lateral inboard tilting of the torso. Seventeen sled tests were conducted in a mid-sized vehicle body at 64 km/h (European New Car Assessment Programme [Euro NCAP] Offset Deformable Barrier [ODB] pulse), in full frontal and oblique (15°) crash directions. The rear-seated HIII 6-year-old child ATD was restrained on a high-back booster seat. In 10 tests, the booster seat was also attached with a top tether. In the oblique tests, the ATD was positioned on the far side. Three camera views and ATD responses (head, neck, and chest) were analyzed. Results: The shoulder belt slipped off the shoulder in all ATD positions in the oblique test configuration. In full frontal tests, the shoulder belt stayed on the shoulder in 3 out of 9 tests. Head acceleration and neck tension were decreased in the forward leaning positions; however, the total head excursion increased up to 210 mm compared to te reference position, due to belt slip-off and initial forward leaning position. Conclusions: These results suggest that real-world child passenger postures may contribute to shoulder belt slip-off and increased head excursion, thus increasing the risk of head injury. Restraint system development needs to include a wider range of sitting postures that children may choose, in addition to the specified postures of ATDs in seating test protocols, to ensure robust performance across diverse use cases. In addition, these tests revealed that the child ATD is limited in its ability to mimic real-world child passenger postures. There is a need to develop child human body models that may offer greater flexibility for these types of crash evaluations.

Objectives To establish the crash risk for drivers with epilepsy and quantify any impacts on on-road driving performance. Methods A systematic search of public health-, psychology-, and transport-databases was conducted. This systematic review was registered with PROSPERO (see CRD42019129664). The quality of evidence for each study was rated using the National Heart, Lung and Blood Institute Quality Assessment tools. Results Twenty-three studies using various designs published between 1961 and 2017 met the inclusion criteria (n = 18 rated ‘good’ or ‘fair’). Of these 18 studies, only 11 (case-control: n = 2; cohort: n = 8; cross-sectional: n = 1) specifically addressed crash risk for drivers with epilepsy, with five reporting evidence for increased crash risk, (n = 3 rated ‘good), three reporting evidence no difference in crash risk relative to controls (n = 2 rated ‘good’), and three reporting inconclusive evidence (n = 1 rated ‘good’. The remaining seven studies examined crash responsibility, injury severity, anti epileptic medicine, seizure-free intervals, and the influence of auras for drivers with epilepsy. No studies investigated the impacts of epilepsy on on-road driving performance. Significance There is evidence for a slight elevation of risk for drivers with epilepsy. Generalisability is limited by lack of controlling for confounds and wide time period over which medical treatment and licensing authority requirements applied. Development of consensus based medical and licensing standards taking these findings into account.

There is a concern in the public domain about driving safety among older drivers due the increase in age-associated medical conditions. It is not known how these medical changes impact driving performance and choice of driving environment. This study aimed to compare older drivers’ (≥74 years) driving performance in a naturalistic setting to middle-aged drivers (35–64 years) on their chosen driving environment, and number, type and severity of errors. The effect of sex and perceived driving ability was also examined. Drivers’ performance was studied using the electronic Driving Observation Schedule [eDOS]), a naturalistic observation approach. Fifty-three older (mean age = 80.6 years, 72% male) and 60 middle-aged (mean age = 50.0 years, 50% male) healthy drivers were recruited. Both groups made few driving errors that were mostly low-risk. Driving performance of older adults differed from middle-aged drivers; they drove on simpler routes (fewer intersections and lane changes) and made fewer errors. Findings are likely indicative of older drivers’ use of adaptive strategies to maintain safe driving.

Introduction Child occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children ( Bohman et al., 2011 ). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection. Method Naturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle – instrumented with data acquisition systems, including Microsoft Kinect™ V1 – recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms – filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking. Results This study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses. Summary Optimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system’s skeleton recognition and two novel analytical algorithms to log head location. Practical applications This research will lead to further analysis leveraging Kinect™ raw data – and other NDS data – to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.

Older adults are the fastest growing segment of the driving population. While there is a strong emphasis for older people to maintain their mobility, the safety of older drivers is a serious community concern. Frailty and declines in a range of age-related sensory, cognitive, and physical impairments can place older drivers at an increased risk of crash-related injuries and death. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In-Vehicle Information Systems (IVIS) may provide assistance to older drivers. However, these technologies will only benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) guidelines. However, it is unclear to what extent the declining sensory, cognitive and physical capabilities of older drivers are addressed in the current guidelines. This paper provides a review of key current design guidelines for IVIS and ADAS with respect to the extent they address age-related changes in functional capacities. The review revealed that most of the HMI guidelines do not address design issues related to older driver impairments. In fact, in many guidelines driver age and sensory cognitive and physical impairments are not mentioned at all and where reference is made, it is typically very broad. Prescriptive advice on how to actually design a system so that it addresses the needs and limitations of older drivers is not provided. In order for older drivers to reap the full benefits that in-vehicle technology can afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into HMI design guidelines.

This study investigated parents’ attitudes, knowledge and behaviours relating to their role in protecting and teaching their young children road safety skills; and in particular parents’ perceptions regarding where they thought their child learnt the most about road safety. A questionnaire exploring attitudes, knowledge and behaviours on general road safety was completed by 272 participants with at least one child aged between 3 and 10 years residing in the Australian state of Victoria. Participants were predominantly female (74%); were either married or in a de facto relationship (92%); and had completed secondary school education (73%). General road safety behaviours and attitudes were fairly positive, with most participants reporting that they restrict their alcohol consumption or do not drink at all while driving (98%), they drive at or below the speed limit (85%) and ‘always’ wear their seatbelts (98%). However, more than half of the participants reported engaging in distracting behaviours ‘sometimes’ or ‘often’ (54%) and only half reported never engaging in aggressive driving (49%). Only 77% believed they were their child’s primary learning source for road safety skills (internal locus of control). The remaining 23% believed school, friends or television were the primary source (external locus of control). Parents with an internal locus of control in educating their children about road safety skills were significantly more likely to be educated at a University level or higher and were more likely to reside in metropolitan versus rural/regional areas, compared with parents with an external locus of control. Parents with an internal locus of control typically had greater knowledge about: whether it is legal in Victoria to drive with unrestrained passengers; whether fines were intended for revenue raising; and whether it is OK to drive 10 km/h above the speed limit in some circumstances. This research provides evidence for road safety intervention development, particularly the potential for parents to be the primary trainers in road safety skills.

With little to guide researchers and clinicians on how best to develop driving simulator interventions for ABI survivors, we aimed to describe the development process of a driving simulator intervention for ABI survivors in a rehabilitation setting.Intervention mapping methodology was used as a framework for the development of our driving simulator intervention. A qualitative synthesis of theoretical and empirical literature and stakeholder meetings enabled identification of factors affecting return to driving, selection of justifiable intervention goals, and identification of appropriate theoretically-informed techniques to facilitate change. These were used as a basis for design of intervention components and materials. A plan for delivery, implementation and evaluation was then developed.Determinants of driving ability, including knowledge and skills, self-efficacy, self-awareness of driving skills, awareness of risk and compensatory strategies were identified. These were applied to a range of tactical and operational driving behaviours to identify targets for change. Theoretically-informed strategies included direct instruction, repetition, graded difficulty, feedback and tailoring. An eight-session protocol, with a corresponding clinical manual, was developed for brain-injured patients who were referred for occupational therapy driving assessment. Protocols for recruitment, inclusion/exclusion criteria and facilitator training were developed, as well as a plan for evaluating feasibility, acceptability and effectiveness.Intervention mapping was a useful approach to systematically develop an intervention tailored to the rehabilitation hospital context to complement existing driver rehabilitation. The feasibility and effectiveness of the simulator programme developed in this study will be evaluated in future studies.IMPLICATIONS FOR REHABILITATIONWe were able to gather important information and provide recommendations to tailor a new driving simulator intervention for individuals with acquired brain injury within a rehabilitation service.The processes and methods described provide researchers and clinicians with a systematic process for the selection of driving simulator intervention components and delivery.This investigation can be used to educate rehabilitation clinicians and technicians to improve driver training and delivery to acquired brain injury survivors.

Objective: Child occupant behavior and head position when travelling in child restraint systems (CRS) may have an effect on injury risk in the event of a motor vehicle crash. The current study aimed to describe the common characteristics and behaviors of child occupants during everyday, real-world motor vehicle travel in a sample of Australian families to identify potential safety implications of observed behaviors and head position within the CRS. Methods: Two instrumented study vehicles were used by 42 families for approximately two weeks. Continuous video and audio data were collected across 1,651 trips (over 600 hours). An online survey provided additional parent, familial and child occupant data. The characteristics and behaviors of 72 child occupants (aged 14 months to 9 years) who travelled in a forward-facing CRS (FFCRS) or a belt-positioning booster seat (BS) were observed and recorded by manual review of a sample of the video/audio recordings. One quarter of all trips (n = 414) was randomly selected for coding/analysis and, within each trip, one child occupant was selected who was travelling in a FFCRS or BS. Child occupant behaviors, head position within the FFCRS or BS, and other relevant information was coded for each trip during nine discrete five second intervals or ‘epochs’ (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip duration). Results: In the majority of epochs (74%), child occupants’ heads were observed to be ‘optimally’ positioned within the FFCRS or BS. For more than half of the epochs, child occupants were observed to be: correctly restrained (58%) and involved in an interaction with another vehicle occupant (59%). Bivariate analyses revealed that children travelling in a FFCRS were significantly more likely to be observed to have optimal head positions than those travelling in a BS (78% vs. 62%), χ2 (1) = 86.00, p < 0.001. Child occupants who were observed to be ‘correctly’ restrained were significantly more likely to be observed to have optimal head positions than those who were observed to be ‘incorrectly’ restrained (80% vs. 20%), χ2 (1) = 10.33, p < 0.01. Conclusions: This is the first naturalistic driving study (NDS) to specifically explore the factors associated with child occupants’ head position when travelling in a CRS. Findings from the current study can be used to inform the positioning of anthropometric test dummies (ATD) in CRS testing, guide improvements to CRS/vehicle design, and develop targeted educational strategies to improve child occupant safety.

Older drivers' self-awareness of driving ability can prompt self-regulatory behaviors and modifications of their everyday driving performance. To date, studies have yet to examine how older drivers' self-awareness of changes in driving ability over time or identify the characteristics of those who can accurately monitor such changes. 64 older drivers (Age: Mean = 80.0 years, SD = 5.4; male: 70 %) were recruited and categorized into four groups based on the correspondence of changes in their perceived and actual driving ability over one year: 40 % of the participants were accurate in their stable or better driving ability over time, 30 % did not detect their driving performance had worsened and over-estimated their driving ability, and the remainder either accurately detected their performance had worsened or under-estimated their driving performance. No demographic or clinical factors were associated with older drivers' self-awareness of changes in driving ability over time, except the mental processing and executive functioning measured using the Trail Making Tests Part B, showed a marginal effect. Implications for clinical importance are discussed.

The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns.Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle.During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198).These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.

To examine self-rated, clinician-rated, and self-awareness of on-road driving performance in individuals with traumatic brain injury (TBI) deemed fit and unfit to resume driving and healthy controls, and to explore their associations with demographic, injury, cognitive, and mood variables.Participants included 37 individuals with moderate to severe TBI, and 49 healthy age, sex, and education-matched controls from Australia and Canada. Participants completed an on-road assessment, the Brain Injury Driving Self-Awareness Measure (BIDSAM), and a comprehensive neuropsychological assessment.Awareness scores on the BIDSAM were significantly different between groups, F(2, 83) = 28.44 (P.001; η = 0.41), with post hoc tests indicating TBI participants who failed the on-road assessment had worse scores compared with those who passed and controls. Poor self-awareness was significantly correlated with reduced psychomotor speed (rs = -0.37; P.01) and attentional switching (rs = 0.28; P.01). Worse self-ratings of driving were associated with depression (rs = 0.42; P.01) and anxiety (rs = 0.38; P.01).Individuals with TBI who failed an on-road assessment significantly overestimated their driving ability. Impaired cognitive function was associated with reduced self-awareness of driving. These findings suggest impaired awareness of driving may need to be addressed as part of driver rehabilitation programs.

The aim of this study was to explore self-reported driving habits and the factors associated with these within the first three months of return to driving following traumatic brain injury (TBI). Participants included 24 individuals with moderate to severe TBI (post-traumatic amnesia duration M = 33.26, SD = 29.69 days) and 28 healthy age, education, and gender-matched controls who completed an on-road assessment. Driving frequency and avoidance questionnaires were administered to assess premorbid driving, anticipated driving upon resuming, and driving at three months post-assessment. There were no differences between groups for premorbid driving frequency or avoidance. Individuals with TBI anticipated greater reductions in driving frequency, t(29.57) = -3.95, p

Restraint performance is evaluated using anthropomorphic test devices (ATDs) positioned in prescribed, optimal seating positions. Anecdotally, humans-children in particular-assume a variety of positions that may affect restraint performance. Naturalistic driving studies (NDSs), where cameras and other data acquisition systems are placed in a vehicle used by participants during their regular transportation, offer means to collect these data. To date, these studies have used conventional video and analysis methods and, thus, analyses have largely been qualitative. This article describes a recently completed NDS of child occupants in which their position was monitored using a Kinect sensor to quantify their head position throughout normal, everyday driving trips.A study vehicle was instrumented with a data acquisition system to measure vehicle dynamics, a set of video cameras, and a Kinect sensor providing 3D motion capture at 1 Hz of the rear seat occupants. Participant families used the vehicle for all driving trips over 2 weeks. The child occupants' head position was manually identified via custom software from each Kinect color image. The 3D head position was then extracted and its distribution summarized by seat position (left, rear, center) and restraint type (forward-facing child restraint system [FFCRS], booster seat, seat belt).Data from 18 families (37 child occupants) resulted in 582 trips (with children) for analysis. The average age of the child occupants was 45.6 months and 51% were male. Twenty-five child occupants were restrained in FFCRS, 9 in booster seats, and 3 in seat belts. As restraint type moved from more to less restraint (FFCRS to booster seat to seat belt), the range of fore-aft head position increased: 218, 244, and 340 mm on average, respectively. This observation was also true for left-right movement for every seat position. In general, those in the center seat position demonstrated a smaller range of head positions.For the first time in a naturalistic setting, the range of head positions for child occupants was quantified. More variability was observed for those restrained in booster seats and seat belts than for those in FFCRS. The role of activities, in particular interactions with electronic devices, on head position was notable; this will be the subject of further analysis in other components of the broader study. These data can lead to solutions for optimal protection for occupants who assume positions that differ from prescribed, optimal testing positions.

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field‐related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self‐referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

AIM: The aim of this study was to develop and provide initial validation data for a self-awareness of on-road driving ability measure for individuals with brain injury. METHOD: Thirty-nine individuals with Traumatic Brain Injury completed an on-road driving assessment, the Self-Regulation Skills Interview (SRSI) and the newly developed Brain Injury Driving Self-Awareness Measure (BIDSAM). RESULTS: BIDSAM self, clinician and discrepancy scales demonstrated high levels of internal consistency (α = 0.83-0.92). Criterion-related validity was established by demonstrating significantly higher correlations between clinician ratings and on-road performances, rs = 0.82, P CONCLUSIONS: These results provide initial support for the BIDSAM as a reliable and valid measure of self-awareness of on-road driving ability following TBI.© 2016 Occupational Therapy Australia. Language: en

Developing tools that accurately detect at-risk driving behaviors is a public-health priority. There is a need for a measure that accurately assesses older drivers’ level of competence on familiar roadways. The objective of this presentation is to describe the development of the procedures and scoring of a new approach, the Electronic Driving Observation Schedule (eDOS), to observe everyday driving in the community. The eDOS was used to record and compare the driving environment and performance of older drivers and low-risk younger drivers during their everyday driving. Older (n=160, >74y) and younger (n=60, 35-64y) drivers completed a 20-30-minute drive from their home to destinations of their choice. Older drivers drove on simpler routes with fewer intersections and lane changes. Both groups made few driving errors, which were mostly low-risk. Younger drivers tended to demonstrate poor driving habits (not signaling, speeding, poor lane position) and compliance with road rules. Part of a symposium sponsored by Transportation and Aging Interest Group.

Naturalistic driving research shows that drivers spend vast amounts of time engaging in secondary, non-driving tasks. Laboratory and simulation studies have demonstrated that, when engaging in a secondary task, drivers adopt strategies to interrupt, delay and resume the secondary task in order to manage their workload and risk. However, there is very little knowledge of the time-sharing strategies that drivers adopt for interweaving their attention across multiple tasks in real-world driving. This study examined the nature of observable visual and/or manual secondary task interruptions in real-word driving using naturalistic driving data. Video of 186 randomly selected trips from the Australian Naturalistic Driving Study were viewed to identify a range of secondary tasks and whether, when and why drivers interrupted engagement in these secondary tasks. It was found that under everyday naturalistic driving conditions, drivers interrupt (or temporarily disengage from) only a small percentage (13.5%) of the secondary tasks engaged in, with 87 percent of these tasks interrupted to re-engage in the driving task. The number of interruptions made to secondary tasks was found to differ according to a number of task characteristics, including task duration and visual load, with tasks of longer duration and higher visual load more likely to be interrupted. The results have a range of practical implications, particularly for the design of in-vehicle devices that better support drivers to break down long tasks into a series of sub-tasks, so that they can more easily disengage when driving demands necessitate.

Objective This study examined the relationship between restraint design features and comfort, posture and seat belt position of children in booster seats during a driving trial. The relationship between comfort and errors introduced by a child throughout a trip were also explored. Method Fifteen children were recruited in this study. Due to technical issues affecting video capture of three participants, the comfort, belt fit, errors and posture of twelve Australian children aged 4–8 years were analysed during two, one hour on-road drives in an instrumented study vehicle fitted with in-vehicle video monitoring equipment. Each child sat in two different types of booster seats, which varied markedly in design. Restraint 1 featured an adjustable headrest, sash belt guide and side wings, whilst Restraint 2 had a longer cushion length (R1: 29 cm, R2: 34 cm), no sash belt guide or side wings. Three five-minute video segments were analysed per seating condition; at the beginning, middle and end of the trip. The Discomfort Avoidance Behaviour (DAB) rate, DAB time, errors and average participant trip time observed in shoulder belt, sagittal torso and head positions were quantified. Results The average DAB rate was higher in R2 than R1 (R2 = 2.79 vs. R1 = 1.85, p = 0.009) and the average number of errors across time points was greater in R2 than R1 (R2 = 0.81 vs. R1 = 0.38, p = 0.01). The DAB rate was associated with increases in the number of child induced errors (log (errors in use) = −2.07 + 0.57 × DAB, p Conclusions The design of a restraint and its influence on comfort, errors, shoulder belt fit and posture may provide an effective avenue to enhance the correct use of child restraints throughout a trip.

The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with restraints at the point of sale could be highly cost-effective and achieve similar benefits to restraint-fitting services or hands-on training; however, routinely supplied instructions in their current form are frequently difficult to understand. We are conducting a randomised controlled trial of the consumer-driven redesign of instructional materials, consisting of an instruction sheet, swing tags and online training videos. This paper presents the protocol that will be used in an innovate process evaluation that will use the primary outcome of overall serious misuse assessed at six months, together with a survey and semi-structured interviews to determine fidelity, dose and outcomes for all intervention participants. The study will assess intervention delivery and external factors that may impact the effectiveness of the intervention, including experience, health literacy, confidence and attitudes. When it has been conducted, this process evaluation will provide enhanced understanding of the mechanisms through which the intervention works or not, aspects of the implementation process key to success of the intervention and insight into how external factors influence the success of the intervention.

Objective This exploratory study examined the concept of psychological resilience and self-reported measures of driving comfort, abilities, and self-regulatory driving behavior in adults aged 75 years and older (Male: 69.9%; Mean age = 81.6 years, SD = 3.3, Range = 76.0–90.0). As resilience is associated with adaptive coping skills, it was anticipated that older drivers with higher resilience scores would be more likely to exhibit self-regulatory driving behavior. Method Participants from the Ozcandrive older driver cohort study (Melbourne, Australia) completed: a demographic questionnaire; a battery of functional/health assessments; driving comfort, perceived abilities and self-regulatory scales; and a resilience scale. Data for a subset of 183 participants were analyzed. Results Hierarchical regression analyses using age, sex, driving exposure, and resilience showed that adding resilience into the models resulted in statistically significant increases in the amount of variance explained, however, the resulting total R-squared values remained modest (i.e. R2 between 0.074 and 0.305). After combining all variables into each model, resilience remained significant in all models except situational driving avoidance. Findings for females support the hypothesis that those with higher resilience report more self-regulatory driving behavior, with contrasting findings for males. Discussion The current findings add to the literature on factors influencing later-life driving decisions and provide more information for extending safe mobility for older adults. The study highlights a promising new domain of research to understand how older adults navigate the process of aging and driving and can provide stakeholders with more information to best prepare for the transportation and mobility issues that lie ahead.

Introduction This study systematically reviewed the literature on key issues relating to the safety benefits of older drivers attending an in-person licence renewal. This included identifying: 1) screening tools that are suitable for inclusion in a populationbased in-person licence renewal process for drivers aged 75 years and older which: a) can be administered by non-health professionals (or via a computer terminal/smart device), and b) are compatible with Australian fitness to drive requirements; 2) the evidence that in-person licence renewal policies are associated with safety benefits, as defined by: a) a reduction in motor vehicle crash risk, or b) on-road driving test outcomes. Methods This review was registered with PROSPERO 2019: CRD42019120809. A systematic search of public health, psychology and transport databases was conducted on March 20th 2019. Results Five studies published between 1986 and 2011 met the inclusion criteria. The review did not identify any suitable screening tools for inclusion in a population-based in-person licence renewal process for older drivers. There was inconclusive evidence regarding the safety benefits associated with in-person licence renewal policies for older drivers. Two studies reported that these policies were associated with a reduced crash risk. However, two studies reported that these policies were not associated with a reduced crash risk, and a third study provided inconclusive evidence. It is important to note that the included studies were conducted across different licensing jurisdictions, with different in-person licence renewal policies – both with and without vision and cognitive testing, which limit the generalisability of the findings. Conclusions It is recommended that a population-based controlled research study in multiple licensing jurisdictions is conducted to specifically investigate the safety benefits of in-person licence renewal policies, as well as the efficacy of different components (including screening by health professionals prior to renewal), as a means to reduce road trauma.

This study compared older drivers’ driving patterns during a naturalistic on-road driving task (i.e., eDOS driving task) with their real-world driving from the preceding four-month period. Two hundred and eight participants (Male: 68.8%; Mean age = 81.5 years, SD = 3.3 years) completed the eDOS driving task in their own vehicle which commenced from their home and followed a self-selected route. Participants’ driving patterns were collected via an in-car recording device that was installed in their vehicle. This study examined the sub-trip from participants’ homes to their first destination during the eDOS driving task. The median sub-trip distance was 4.4 km (Q1 = 2.8, Q3 = 6.4). Across the four-month period of real-world driving, participants completed a median of 151 driving trips from their home (Q1 = 103.0, Q3 = 202.7), with a median trip distance of 2.7 km (Q1 = 1.1, Q3 = 5.8). Most participants’ eDOS driving task trip distance was classified as representative of their real-world driving trip distances (95.2%). By mapping GPS coordinates for driving pattern data with road types and roadways, most eDOS driving task trips included roadways that were actively used during their real-world driving (85.0%). During the preceding four-month period of real-world driving, most participants had visited the first nominated destination during the eDOS driving task at least once per month (77.4%). Given the increasing international interest and use of modified (local area) licences, these findings suggest that naturalistic on-road driving tasks could be used by licensing authorities to assess potentially at-risk older drivers within their own driving environments.

Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population.The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk.We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence.Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke.The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.

Objective: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy controls, and the injury and cognitive factors associated with driving performance. Study design: Cross-sectional. Methods: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures. Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills. Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.Implications for rehabilitationClinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury. Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries. Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres. Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury. Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.

Motor vehicle crashes are a major cause of death and injury to children worldwide. Although risk of injury to child passengers can be reduced by using a child restraint, most restraints are incorrectly used. This greatly reduces the restraints’ protective potential; however there is limited research on drivers of correct child restraint use. The aim of this study was to explore perceived barriers and motivators of correct child restraint use in experienced child restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect child restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) child restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a child restraint; and (d) low confidence in ability to install and use a child restraint correctly. The results indicate current child restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct child restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process.

OBJECTIVE: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHODS: The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). CONCLUSIONS: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

BackgroundWith long-standing and widespread high rates of errors in child restraint use, there is a need to identify effective methods to address this problem. Information supplied with products at the point of sale may be a potentially efficient delivery point for such a countermeasure. The aim of this study is to establish whether product materials developed using a consumer-driven approach reduce errors in restraint use among purchasers of new child restraint systems.MethodsA cluster randomised controlled trial (cRCT) will be conducted. Retail stores (n=22) in the greater Sydney area will be randomised into intervention sites (n=11) and control sites (n=11), stratified by geographical and socioeconomic indicators. Participants (n=836) will enter the study on purchase of a restraint. Outcome measures are errors in installation of the restraint as observed by a trained researcher during a 6-month follow-up home assessment, and adjustment checks made by the parent when the child is placed into the restraint (observed using naturalistic methods). Process evaluation measures will also be collected during the home visit. An intention-to-treat approach will be used for all analyses. Correct use and adjustment checks made by the parent will be compared between control and intervention groups using a logistic regression model. The number of installation errors between groups will be compared using Poisson regression.DiscussionThis cRCT will determine the effectiveness of targeted, consumer-driven information on actual error rates in use of restraints. More broadly, it may provide a best practice model for developing safety product information.Trial registration numberACTRN12617001252303p; Pre-results.

To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation.A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n = 74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n = 32).No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group.Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury. Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term. Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

To determine the extent and nature of driving self-regulation in drivers with Parkinson disease (PD) and factors associated with self-regulatory practices.Although people with PD have consistently been shown to have driving impairments, few studies have examined self-regulatory driving practices and their relationship to driving performance.We used a self-report driving questionnaire to examine driving self-regulation in 37 drivers with PD and 37 healthy age-matched controls. We also analyzed factors associated with self-regulatory practices, primarily demographic, disease-related, psychological, and simulated driving performance variables.The drivers with PD reported significantly higher rates of self-perceived decline in their driving ability (P=0.008) and driving significantly shorter distances per week (P=0.004) than controls. Unfamiliar situations (P=0.009), in-car distractions (P0.001), low visibility conditions (P=0.004), and long journeys (P=0.003) were particularly challenging for the drivers with PD, and their pattern of driving avoidance mirrored these difficulties. The use of self-regulatory strategies among drivers with PD was associated with female sex (rho=0.42, P=0.009) and perceived decline in driving ability (rho=-0.55, P0.001), but not with age or objective measures of disease severity, cognition, or simulated driving performance.Drivers with PD reported driving less overall and restricting their driving to avoid particularly difficult circumstances. Further research is warranted on effective use of self-regulation strategies to improve driving performance in people with PD.

This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%).RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.

A key tenet of the safety in numbers theory is that as the number of people cycling increases, more drivers will also be cyclists and therefore will give greater consideration to cyclists when driving. We tested this theory in relation to self-reported behaviour, attitudes and knowledge in relation to cycling. An online survey was conducted of Australian drivers (n=1984) who were also cyclists (cyclist-drivers) and drivers who did not cycle (drivers). Cyclist-drivers were 1.5 times more likely than drivers to report safe driving behaviours related to sharing the roads with cyclists (95% CI: 1.1-1.9, p0.01). Cyclist-drivers had better knowledge of the road rules related to cycling infrastructure than drivers; however knowledge of road rules related to bike lanes was low for both groups. Drivers were more likely than cyclist-drivers to have negative attitudes (e.g. cyclists are unpredictable and repeatedly overtaking cyclists is frustrating). Findings from this study highlight the need for increased education and awareness in relation to safe driving behaviour, road rules and attitudes towards cyclists. Specific recommendations are made for approaches to improve safety for cyclists.

Passenger collaboration offers a potential compensatory strategy to assist older drivers who have difficulty driving in unfamiliar areas (wayfinding). This article describes a survey of 194 healthy, community-dwelling older drivers and their regular passengers to investigate how passengers assist drivers, and to identify the characteristics of drivers and passengers who regularly collaborate to assist with wayfinding. Three aspects of passenger assistance were investigated: Pre-trip planning, directional guidance and searching for visual cues. Results revealed a high incidence of collaboration amongst drivers and passengers who regularly drive together. Collaboration was dependent on the perceived wayfinding abilities of the driver by both passenger and driver, suggesting that passengers are more likely to help if they think they will be of assistance. This information provides baseline information on which future research can examine the safety benefits of passenger assistance in wayfinding.

As people age into older adulthood, they are more likely to experience events that impact their driving, such as age-related cognitive and functional declines, serious illness, or disability. The ability to demonstrate resilience following such adversity may influence one’s decisions and feelings about driving. This study investigated whether resilience of older drivers changes over time, and if relationships between resilience, gender, and self-reported driving-related abilities, perceptions and practices remain stable or change. Participants were from the Candrive/Ozcandrive study, a prospective cohort study of older drivers from Canada, Australia and New Zealand. Analyses are presented from a subset of Ozcandrive participants (n=125) from Australia who completed a resilience scale at two time points approximately five years apart, as well as measures of driving comfort during the day and night, perceived driving abilities, and driving frequency. Participants were primarily male (67.2%) with a mean age of 81.6 years (SD=3.3, Range=76.0-90.0) at Time 1. Resilience increased significantly from Time 1 to Time 2 (Median=82.0/84.00, z=-2.9, p

The primary objective of this study was to better understand how self-regulatory driving practices at multiple levels of driver decision making are influenced by various factors. Specifically, the study investigated patterns of tactical and strategic self-regulation among a sample of 246 Australian older drivers. Of special interest was the relative influence of several variables on the adoption of self-regulation, including self-perceptions of health, functioning, and abilities for safe driving and driving confidence and comfort.The research was carried out at the Monash University Accident Research Centre, as part of its Ozcandrive study, a partnership with the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive), and in conjunction with the University of Michigan Transportation Research Institute (UMTRI). Candrive/Ozcandrive represents the first study to follow a large group of older drivers over several years and collect comprehensive self-reported and objectively derived data on health, functioning, and driving. This study used a subset of data from the Candrive/Ozcandrive study. Upon enrolling in the study, participants underwent a comprehensive clinical assessment during which data on visual, cognitive, and psychomotor functioning were collected. Approximately 4 months after study enrollment, participants completed the Advanced Driving Decisions and Patterns of Travel (ADDAPT) questionnaire, a computer-based self-regulation instrument developed and pilot-tested at UMTRI.Self-regulation among older adults was found to be a multidimensional concept. Rates of self-regulation were tied closely to specific driving situations, as well as level of decision making. In addition, self-regulatory practices at the strategic and tactical levels of decision making were influenced by different sets of factors.Continuing efforts to better understand the self-regulatory practices of older drivers at multiple levels of driver performance and decision making should provide important insights into how the transition from driving to nondriving can be better managed to balance the interdependent needs of public safety and personal mobility.

This paper describes the development and evaluation of an on-road procedure, the Driving Observation Schedule (DOS), for monitoring individual driving behavior. DOS was developed for use in the Candrive/Ozcandrive five-year prospective study of older drivers. Key features included observations in drivers’ own vehicles, in familiar environments chosen by the driver, with start/end points at their own homes. Participants were 33 drivers aged 75+ years, who drove their selected route with observations recorded during intersection negotiation, lane-changing, merging, low speed maneuvers and maneuver-free driving. Driving behaviors were scored by a specialist occupational therapy driving assessor and another trained observer. Drivers also completed a post-drive survey about the acceptability of DOS. Vehicle position, speed, distance and specific roadways traveled were recorded by an in-vehicle device installed in the participant's vehicle; this device was also used to monitor participants’ driving over several months, allowing comparison of DOS trips with their everyday driving. Inter-rater reliability and DOS feasibility, acceptability and ecological validity are reported here. On average, drivers completed the DOS trip in 30.48 min (SD = 7.99). Inter-rater reliability measures indicated strong agreement between the trained and the expert observers: intra-class correlations (ICC) = 0.905, CI 95% 0.747–0.965, p < 0.0001; Pearson product correlation, r (18) = .83, p < 0.05. Standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV) measures were consistently small (3.0, 2.9 & 3.3%, respectively). Most participants reported being ‘completely at ease’ (82%) with the driving task and ‘highly familiar with the route’ (97%). Vehicle data showed that DOS trips were similar to participants’ everyday driving trips in roads used, roadway speed limits, drivers’ average speed and speed limit compliance. In summary, preliminary findings suggest that DOS can be scored reliably, is of feasible duration, is acceptable to drivers and representative of everyday driving. Pending further research with a larger sample and other observers, DOS holds promise as a means of quantifying and monitoring changes in older drivers’ performance in environments typical of their everyday driving.

A cyclist crash with an open vehicle door can result in serious injury, sometimes fatal, outcomes. However, little is known about the frequency and range of injury outcomes of this crash type or the contributing factors. In this study, the factors associated with cyclist-open vehicle door collisions in Victoria, Australia were investigated using three complementary data sources: (1) police reported crashes (2000–2011); (2) hospital presentations (2000–2010), and (3) a sample of video footage from a naturalistic study of commuter cyclists in Melbourne (2009–2010). A total of 1247 police reported cyclist crashes and 401 hospital emergency department presentations were analysed. As a proportion of all cyclist crashes, cyclist-open vehicle door crashes accounted for 3.1% (hospital) and 8.4% (police). The majority of cyclists injured were: male (police: 67.1%; hospital: 65.8%); adults aged 18 years or older (police: 97.5%; hospital: 96.3%), and crashes occurred in speed zones up to 60 kph (police: 93.1%). From the naturalistic cycling study, there were 13 door-related events with a rate of 0.59 events per trip. No collisions occurred and in all cases, a potential collision was avoided by the cyclists’ evasive action. Most drivers did not look in the direction of the cyclist before opening the door. While the number of reported crashes is relatively low, cyclists’ exposure to events with potential for this crash type is high. Potential countermeasures to reduce the risk of this interaction/crash type are discussed and include road environment design improvements and road user behaviour programs.

Some older drivers experience difficulties driving whilst wayfinding in unfamiliar areas. Difficulties in wayfinding have been associated with poorer driving performance and reduced driving mobility. The objective of the current study was to identify cognitive and demographic predictors in older drivers of perceived wayfinding difficulty, avoidance of unfamiliar areas and the use of wayfinding strategies. Five hundred and thirty-four drivers aged 65 years and over (excluding those with dementia or Parkinson's disease) completed a mail-out survey. Drivers commonly reported difficulties with wayfinding, with 59.5% reporting their abilities as poor or fair rather than good. Those significantly more likely to report difficulty were older, reported poorer health and cognition, and had less driving experience. A small proportion of drivers reported regularly avoiding unfamiliar areas (13.8%); these drivers were significantly more likely to be female and to report poorer wayfinding abilities. The most common wayfinding strategies regularly used by older drivers were using a street directory whilst driving (61.9%) and pulling over to check the map (55.1%). Regular passenger guidance (23.9%) or use of a navigation system (9.9%) was less common. The implications of this study are wide and include collecting further information about: (1) the role of cognitive processes in wayfinding ability; (2) the relationship between perceived wayfinding difficulty and restriction of driving in unfamiliar areas; and (3) older drivers' preferences for different wayfinding strategies.